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Current pharmacotherapies for opioid dependence.
1Substance Abuse Treatment Unit, Yale University School of Medicine, New Haven, CT 06511.
Psychopharmacology Bulletin
|January 1, 1990
Summary
Opioid abuse treatment requires effective maintenance pharmacotherapies like methadone, naltrexone, and investigational drugs (LAAM, buprenorphine) to prevent relapse and support abstinence.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- The acquired immunodeficiency syndrome (AIDS) epidemic has increased the urgency for effective pharmacotherapy in intravenous opioid abusers.
- Intravenous drug abuse contributes significantly to new AIDS cases in urban areas.
Purpose of the Study:
- To review the clinical use, limitations, and outcomes of current and investigational maintenance pharmacotherapies for opioid dependence.
- To address the need for sustained abstinence and relapse prevention in opioid abusers.
Main Methods:
- Review of clinical use, limitations, and outcomes of methadone and naltrexone.
- Evaluation of investigational treatments: levo-alpha-acetylmethadol (LAAM) and buprenorphine.
- Consideration of pharmacotherapy for acute dependence, withdrawal, and protracted abstinence.
Main Results:
- Clonidine is beneficial for acute dependence and withdrawal, especially with antagonist-precipitated withdrawal.
- Methadone and naltrexone are established maintenance therapies, with methadone being more common.
- LAAM and buprenorphine show promise as long-acting maintenance agents with distinct properties.
Conclusions:
- Effective maintenance pharmacotherapy is crucial for sustained opioid abstinence and retention in treatment.
- Investigational agents like LAAM and buprenorphine offer alternatives to current therapies, addressing their limitations.
- Pharmacotherapy plays a vital role in managing opioid abuse, particularly in the context of the AIDS epidemic.